Word of the Day / Sharap: Paying Extra for Better Medical Care

An acronym standing for 'private medical services' is a polarizing issue in Israeli politics, though its derivation is quite straightforward.

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Sharap: An operating room in Ichilov Hospital, Tel Aviv
Sharap: An operating room in Ichilov Hospital, Tel AvivCredit: Moti Milrod

Medical acronyms don’t often make the headlines, but when a committee led by Health Minister Yael German recommended last week that public hospitals be barred from providing private health care, the local news abounded with the Hebrew acronym for the term meaning “private medical services”: not PMS, but sharap, which stands for sherut refu’i prati (sometimes spelled out as sherutei refu’ah pratit).

The removal of the parts necessary for the acronym is about as straightforward a surgery as you can get. Carefully snip off the first letter of each word, to get sh-r-p (the “sh” sound is represented by a single letter in Hebrew). Then add a transfusion of a basic vowel sound to make the word flow more easily, and you get sharap.

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The sharap debate is a polarizing one in a country that still clings tightly to its socialist kibbutz-style roots. Proponents – very much including the doctors and hospitals that would stand to benefit from allowing sharap to extend beyond private hospitals like Jerusalem’s Hadassah, whose highly publicized financial collapse this year seems likely to have influenced the committee’s decision – argue that allowing patients to pay for the privilege of choosing the top surgeons (whether out of pocket or through private insurance) would give the most in-demand doctors an incentive to continue working in Israeli hospitals and would regulate any black-market fees some doctors might demand.

Critics say extending sharap would increase the gap between rich and poor, making it easier for the government to be lax in its oversight of the basic services the hospitals are providing because those most likely to effect change would be the ones least likely to do so, since they can afford to pay extra for what they wanted.

I had no personal experience with sharap until a few weeks ago, when one of my daughters had her adenoids removed and her tonsils reduced at Hadassah University Hospital, Ein Karem. We inadvertently experienced both the benefits of having sharap as well as the disadvantages of being one of the non-sharap masses, since my daughter, who is almost 5, somehow got registered as a private patient even though we had not requested the privilege of paying extra.

The mistake was not discovered until the morning after the surgery, when we got a call that we had to go to the sharap office to pay up before we could be discharged. My daughter had been assigned to a room with one other child, which we had initially thought was normal – until my husband discovered in the course of the night that there was another room on the pediatric floor, a larger one that was crammed full of young patients and their tired parents. When the call came the next morning, the penny dropped and we realized the reason for the special treatment.

When the bureaucratic mess finally got sorted out, I was left to try to make a follow-up appointment with the same doctor, as both he and the nurse had explicitly told us to do. After several frustrating phone calls in which I was told this was impossible because there were no holes in the doctor’s schedule, I finally reached a secretary who had a word or two with the surgeon himself.

“You’re not sharap, right?” she asked, before making it clear that in that case, the doctor would not be in. I don’t know if that’s more of a problem with private medical services or the other kind of PMS – the one that seems to afflict so many of those who are more inclined to say “I can’t help you” than “How may I help you?” no matter the gender or time of the month – but my sharap experience has shown me that while the formation of the acronym may be straightforward, the inner workings of the system are anything but.

To contact Shoshana Kordova with column suggestions or other word-related comments, email her at shoshanakordova@gmail.com. For previous Word of the Day columns, go to: www.haaretz.com/news/features/word-of-the-day.

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